HNBA Executive/Judicial Endorsements Nomination Form

Name:*

First

Last

Address:*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

E-mail 1:*

E-mail 2:*

Work Telephone:*

Cell Number:*

Are you a U.S. Citizen?*

Yes

No

State whether you are a member of the HNBA:*

Yes

No

Facebook:

Twitter:

Instagram:

LinkedIn:

Are you applying for a specific judicial vacancy?*

Yes

No

If so, which one?

List your top three preferred agencies, offices and positions:*

Have you ever used illegal substances?*

Yes

No

Have you ever been convicted of a misdemeanor or a felony?*

Yes

No

Have you ever violated any federal tax, employment, criminal, or other laws?*

Yes

No

If you answered YES to any of the above, please explain in detail.

CV:*

Judicial Endorsement Questionnaire OR Executive Appointment Certification Form:*

Letters of Support (not required):

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